Comparing the Ability of Anesthetic Nurse Trainees to Intubate Using the CombitubeTM VS. Endotracheal Tube
Abstract
Background: The endotracheal intubation (ETT) is the critical airway management in life saving, but major complications, such as esophageal intubation or difficult intubation, may be occurred. The esophageal tracheal CombitubeTM (ETC), a combined endotracheal and esophageal obturator airway adjunct can be prevented these problems.
Objective: To evaluate the ability of anesthetic nurse trainees to use the ETT and ETC, on the manikin.
Design: An experimental study to evaluate the difficult of insertion, recognition of esophageal versus tracheal placement, skill proficiency and satisfaction. The ability to use the device in cases of failed endotracheal intubation also was scrutinized.
Setting: Department of anesthesiology, Srinagarind hospital, Faculty of Medicine, Khon Kaen University, Thailand.
Subjective: Twenty inexperienced anesthetic nurse trainees, who study in department of anesthesiology for 1 year (1 October 1999 to 30 September 2000).
Measurement: The study is separated into 2 periods of time. The first one is on the first day of the training course in the department and the later is on the next 3 months. 1).The intubation time was defined as the time from the preparation of the instruments to the beginning of the intubation until the lungs were inflated and 2).The satisfaction and degree of difficulty for using CombitubeTM by using the questionnaires.
Result: Comparing the both periods of the study to intubation the ETT and the ETC, the study showed that the time for ETT intubation was 29.07 second (95%CI, 16.29,41.94), it showed that there was statistically different as was the degree of difficulty for intubation (both p-value < 0.05). The second period showed that the second intubation was easier than the first one. The time for ETC between both periods were not statistically significant different, however, the within degree of difficulty. The degree of satisfaction vis-á-vis of the two methods between the both periods were not statistically different.
Conclusion: Although visualized endotracheal intubation remains the preferred method of airway control, the CombitubeTM may be an effective emergency and prehospital airway device as both a back up to endotracheal tube and a primary airway. The CombitubeTM dose not require visualization with a laryngoscope, comprehensive training and continuing education on key factors affecting skill retention. We concluded that training ETC intubation by anesthetic nurses (both trainees and those in intensive care) and paramedics would be more successful as well as the older ETT method.
